De-Buzzing Patient-Centered Care

The most important component of patient-centered care is a respect for each patient’s values and preferences, says a prominent advocate.

Susan Edgman-Levitan has devoted her career to improving patient-centered primary care, and she does not appreciate how the term “patient-centered” has become a buzzword that threatens to destroy its true meaning.

“When I’m talking about patient-centered care, I’m not talking about hotel amenities. I’m not talking about the food or the parking or the color of the walls,” says Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation. “I’m talking about the critical aspects of quality of care that patients and clinicians value.”

She starts rattling them off: communicating in a way patients understand, helping patients understand how to take medications, responding when patients need help, and preparing patients for discharge so that they can recuperate successfully at home.“ And the most critical component is respecting the patient’s values and preferences,” says Edgman-Levitan. “You have to understand what those values and preferences are, and then you have to factor those into the treatment plan. I’m passionate about this. We should refocus our question: ‘What is the matter?’ to ‘What matters to you?’”

Shared Decision Making

Based at Massachusetts General Hospital, the Stoeckle Center works with primary care practices to test innovative ideas to improve the delivery of primary care. “We view ourselves as a learning lab, and when something works, we implement it across all of our physician practices and do everything we can to share it with anyone else who is interested in primary care,” says Edgman-Levitan.

One of the things that works: shared decision making, a formal process in which patients’ values and preferences are central considerations in determining which tests and treatments will be used. Starting with a small pilot in 2005, the Stoeckle Center’s Shared Decision Making Program has grown to include nearly 200 physicians employed by Massachusetts General who have recommended more than 10,000 decision aids to their patients.

When a physician at Massachusetts General documents certain medical conditions—for example, knee pain or diabetes—in a patient’s electronic health record (EHR), he or she gets a visual prompt that indicates a decision aid is available. The physician can “prescribe” that aid—available in DVD format—via the EHR, which notifies an administrative center to mail the decision aid to the patient’s home.

Each decision aid explains the treatment or testing options a patient might consider, with experts discussing the evidence about the outcomes of each option. It also includes interviews with patients, who explain why they chose a specific option and how they felt about that choice after the fact.

“One of the most popular decision aids is one on choices about colorectal cancer screening,” Edgman-Levitan says. “One physician told me ‘If I have two weeks with someone, I could not provide information in the comprehensive way that this video does in 20 minutes.’”

The Patient’s Goals

Trained as a physician assistant, Edgman-Levitan is the Institute for Healthcare Improvement’s fellow for patient and family-centered care. She worked in family medicine/primary care in rural North Carolina and helped redesign primary care as a strategic planner for the New York City Health and Hospitals Corporation.

Her commitment to primary care stems in part from her personal interactions with the healthcare system. Her interest in primary care innovation is partly formed by her own search for non-traditional therapies, such as acupuncture and massage, to treat her rheumatoid arthritis.

“One thing that formed my career was my own experience of trying to put together a treatment plan for myself with physicians who were really, really committed to helping me achieve my goals, not theirs,” she says.

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